| NPI | 1477012862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 238288) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 28290A) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL 9429423) | |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2025-02-19 |